Care Conference Stroke

499 views

Published on

Published in: Education, Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
499
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
8
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Care Conference Stroke

  1. 1. At the end of this session, you will be able to :  State the definition of stroke.  List the etiology of stroke.  Identify the pathophysiology of stroke.  State the sign & symptom of stroke.
  2. 2. LEARNING OBJECTIVES cont.  Identify the complication of stroke.  Understand regarding treatment of stroke.  Identify the nursing intervention & appreciate the nursing care for stroke patient.
  3. 3. PATIENT’S PROFILE  MRS. M  FEMALE  75 YEARS OLD  HOUSEWIFE
  4. 4. PATIENT’S PROFILE  TROLLEY  ANXIOUS  ALLERGICS - NIL  D.O.A 9/4/12 @ 1015 Hrs
  5. 5. Mrs M was admitted to 5XX-1 with complaint of right sided weakness, slurred speech, numbness right arm, giddiness, dysphagia, nausea and vomiting X 1/7.
  6. 6. Doctor = Dr AA Diagnosis 1.Stroke 2.High Cholesterol
  7. 7. PATIENT’S PROFILE  MEDICAL HISTORY  Nil  SURGICAL HISTORY  Left eye removal of cataract (2 years ago)  Right eye removal of cataract (1 year ago)  FAMILY MED HISTORY  HPT (mother)
  8. 8. CURRENT MEDICATION  Nil
  9. 9. VITAL SIGN  TEMPERATURE  BLOOD PRESSURE  PULSE  RESPIRATION  PAIN SCORE  Dextrosmeter  Weight : : : : : : 36.8˚C 170/100mmHg 88 bpm 18 bpm 1 8.2 mmol/L : Unfit
  10. 10. ACTIVITY DAILY LIVING  Having difficulty in swallowing  Loss of appetite, nauseated and vomiting  Anxious and asking many questions.  Need assistance in ADL and personal hygeine  On pampers
  11. 11. PHYSICAL EXAMINATION
  12. 12. S/B Dr AA in A&E  17K  CT BRAIN  IV Drip D5% slow  Low fat diet  KIV anti HPT  Dietician advice  ROM exercise
  13. 13. ISCHEMIC STROKE • Occurs when blood clot or thrombus formed and blocked blood flow to part of the brain.
  14. 14. HAEMORRHAGIC STROKE • Occurs when blood vessel ruptured and blood fills space between brain and skull (subarachnoid haemorrhage) or when a defective artery burst and blood fills the surrounding tissue (cerebral haemorrhage).
  15. 15. WHAT pressure High blood CAUSES IT?  High cholesterol  Aging  Stress  Cardiovascular disease  Smoking and alcohol  Diabetes 
  16. 16. RISK FACTORS • Family history • Age over 40 • High BP • High cholesterol • Smoking
  17. 17. RISK FACTORS • African American or Asian • Male • Diabetes • Obesity • Cardiovascular disease • Stress
  18. 18. RISK FACTORS • Previous stroke or TIA • High level of homocysteine (amino acid) in blood • Birth control or hormonal therapy • Cocaine usage • Alcohol
  19. 19. COMPLICATION • Paralysis • Vision loss • Difficulty speaking or swallowing • Memory loss • Death
  20. 20. 17K • ESR - 56 (0 – 20 mm/hr) • Neutropil - 79.9% (40 – 75%) • Lymphocyte - 16.0% (20-45%) • Glucose - 6.9 (3.9 – 6.1mmol/L)
  21. 21. 17K • Total cholesterol - 8.0mmol/L (<5.2) • LDL cholesterol - 5.7mmol/L (<2.6) • Chol/HDL Chol - 4.4 (up to 4.0)
  22. 22. CT BRAIN • Multifocal small cerebral white matter ischemia
  23. 23. DRUGS IN WARD DATE ORDERED DATE OFF IV Nootropil 3gm TDS 9/4/13 12/4/13 Tab Cardiprin 1/1 OD 9/4/13 12/4/13 Tab Vascor 20mg ON 9/4/13 12/4/13 Tab Plavix 75mg Daily 9/4/13 12/4/13
  24. 24. DRUGS ON DISCHARGE DATE ORDERED Tab Vascor 20mg ON 12/4/13 Tab Cardiprin 1/1 ON 12/4/13
  25. 25. Physiotherapy • • • • • • • To normalise muscle tone To restore muscle function To control compensation strategies To maintain muscle length To re-educate balance To retrain walking and restore mobility To maximise functional ability while allowing ongoing neuromuscular recovery
  26. 26. NURSING DIAGNOSIS  Knowledge deficit related to management of blood pressure control.
  27. 27. SUPPORTING DATA  Patient will verbalize understand regarding the management of blood pressure.  Patient will maintain optimal normal blood pressure.
  28. 28. NURSING INTERVENTION  Reinforce about doctor’s explanation.  Monitor blood pressure 4 hourly.
  29. 29. NURSING INTERVENTION  Explain the sign and symptom of high blood pressure :  Headache  Blurring vision  Numbness
  30. 30. NURSING INTERVENTION  Advise patient on dietary plan and provide :  Low salt diet  Low fat diet
  31. 31. NURSING INTERVENTION  Advise patient to do regular follow up.
  32. 32. NURSING INTERVENTION  Advise patient to maintain healthy lifestyle :  Avoid stress  Consume healthy diet and avoid salty and high fat food
  33. 33. NURSING INTERVENTION  Advise patient to do regular exercise.  Encourage family members support.
  34. 34. NURSING INTERVENTION  Explain the complication of high blood pressure :  Influences of cardiovascular  Cerebral  Renal system
  35. 35. NURSING DIAGNOSIS  Alteration in emotional status anxiety related to symptoms of stroke and treatment.
  36. 36. NURSING DIAGNOSIS  Alteration in ADL related to right sided weakness and numbness of right hand.
  37. 37. NURSING DIAGNOSIS  Knowledge deficit related to management of blood glucose control.
  38. 38. NURSING DIAGNOSIS  Potential fall related to right sided body weakness.
  39. 39. NURSING DIAGNOSIS  Alteration in nutritional status less than body requirement related to nausea, vomiting and dysphagia.
  40. 40. NURSING DIAGNOSIS  Potential infection related to intravenous cannulation.
  41. 41. NURSING DIAGNOSIS  Knowledge deficit related to post stroke attack management.
  42. 42. NURSING DIAGNOSIS  Potential alteration in skin integrity related to immobility.
  43. 43. • • • • • • • • Reduce your blood pressure Improve your diet Stop smoking Consider how much alcohol you drink Exercise more Watch your weight Relaxation and stress management Diabetes management

×